Children's Specialized Hospital, New Brunswick, New Jersey;
Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Pediatrics. 2021 Jan;147(1). doi: 10.1542/peds.2019-3659. Epub 2020 Dec 10.
Persistent disparities exist in early identification of autism spectrum disorder (ASD) among children from low-income families who are racial and/or ethnic minorities and where English is not the primary language. Parental literacy and level of maternal education may contribute to disparities. The Developmental Check-In (DCI) is a visually based ASD screening tool created to reduce literacy demands and to be easily administered and scored across settings. In a previous study, the DCI showed acceptable discriminative ability between ASD versus non-ASD in a young, underserved sample at high-risk for ASD. In this study, we tested the DCI among an unselected, general sample of young underserved children.
Six hundred twenty-four children ages 24 to 60 months were recruited through Head Start and Early Head Start. Parents completed the DCI, Modified Checklist for Autism in Toddlers, Revised with Follow-Up, and Social Communication Questionnaire. Children scoring positive on any measure received evaluation for ASD. Those screening negative on both Modified Checklist for Autism in Toddlers, Revised with Follow-Up and Social Communication Questionnaire were considered non-ASD.
Parents were primarily Hispanic, reported high school education or less, and had public or no insurance. The DCI demonstrated good discriminative power (area under the curve = 0.80), performing well across all age groups, genders, levels of maternal education, primary language, and included ethnic and racial groups. Item-level analyses indicated that 24 of 26 DCI items discriminated ASD from non-ASD.
The DCI is a promising ASD screening tool for young, underserved children and may be of particular value in screening for ASD for those with low literacy levels or with limited English proficiency.
在识别来自低收入家庭的、具有少数族裔和/或种族背景且英语非主要语言的儿童的自闭症谱系障碍（ASD）方面，仍然存在持续的差异。父母的文化程度和母亲的受教育程度可能是造成差异的原因。发育检查（DCI）是一种基于视觉的 ASD 筛查工具，旨在降低文化程度要求，并在不同环境中进行简易管理和评分。在之前的一项研究中，DCI 在高 ASD 风险的年轻、服务不足的样本中，显示出了在 ASD 与非 ASD 之间的可接受的鉴别能力。在这项研究中，我们在未选择的、一般的年轻服务不足的儿童样本中测试了 DCI。
通过 Head Start 和 Early Head Start 招募了 624 名 24 至 60 个月大的儿童。父母完成了 DCI、改良婴幼儿自闭症检查表修订版（带后续检查）和社会沟通问卷。任何测试得分阳性的儿童都接受 ASD 评估。那些在改良婴幼儿自闭症检查表修订版（带后续检查）和社会沟通问卷上都筛查为阴性的儿童被认为是非 ASD。
父母主要是西班牙裔，报告高中或以下学历，并且有公共或无保险。DCI 表现出良好的鉴别力（曲线下面积=0.80），在所有年龄组、性别、母亲教育程度、主要语言以及包括的种族和族裔群体中表现良好。项目水平分析表明，DCI 的 26 个项目中有 24 个能够区分 ASD 与非 ASD。
DCI 是一种有前途的年轻服务不足儿童的 ASD 筛查工具，对于那些文化程度低或英语水平有限的人，它可能特别有价值，可以用于 ASD 筛查。
